Patient, client, consumer, or something else?

Now that I have talked a little about myself, it’s time for me to talk about the people who seek my services. I have heard therapists and social workers refer to the people we serve as patients, clients or consumers. Bottom line for me is that my choice of words should reflect the deep respect I have for the people with whom I work, acknowledging as much as possible their intelligence, integrity and capabilities as a fellow human being. I have said before that I regard the people I work with as my equals.

The problem is that words intended to be neutral often develop their own stigma, and this has been particularly true in the area of mental health, because mental illness has been heavily stigmatized.

In my mind, that would rule out using the word “patient.” To someone not familiar with English usage in the U.S. the phrase “mental patient,” might simply refer to someone receiving services from a mental health professional. However, most Americans, when thinking about that phrase, think about someone who has lost their ability to function or who might potentially be threatening.

To me, “patient” also suggests a traditional doctor/patient relationship, where the doctor is the expert and gives orders to the patient. That directive, hierarchical relationship is changing, particularly with younger doctors. But “doctor’s orders” still reflects how people view the doctor-patient relationship, and it’s antithetical to how I view my relationship with the people who seek my services. So for that reason, I avoid using the word “patient.”

“Client” is a word widely used among social workers to describe the people whom they serve. The word “client” is intended to be neutral, signifying someone whom they are doing business with. My father was a public relations consultant and he used the word “client” all the time. But when I worked for a social service agency some years ago, I would sit at lunch with social workers who would vent about their frustrations at work. When I heard them talk about “clients” I could definitely feel a negative spin–I can still hear the word being spoken through clenched teeth. As such, it was not at all a surprise to me when a close friend who was going through difficult times and receiving social services told me, “I hate being a client.” I knew exactly what she was talking about.

The word “consumer” stems from the mental health consumer movement, a movement of people receiving mental health services who have banded together to advocate for themselves. The Merriam-Webster definition of “consumer” means “one whom consumes,” either as a person using economic goods or an organism that needs complex organic compounds by eating other organisms. In the context of mental health services,this means that a person receiving mental health services is entitled to rights and protections in the same way that the consumer movement advocates for people buying other goods and services. People in the mental health consumer movement often stand up against mistreatment of people dealing with mental illness and advocate for systemic changes to improve how mental health professionals and others treat people.

Yet even in this context, the word “consumer” might be demeaning. At least in my mind. The notion of a consumer society often means one where the production and buying of material goods is the most important social activity. Even the Oxford Dictionary website mentions that this word often has a derogatory spin to it.

Yahara House is a mental health organization here in Madison that I have a lot of respect for. The people who receive mental health services from the organization are, to a large extent, the people who also run it. I once interviewed with the organization and was profoundly moved by the fact that people receiving mental health services were part of the committee interviewing me. They told me that they avoid the use of the words “patient,” “client,” and “consumer” in favor of the word “members,” since that is the official relationship between the organization and the people it serves. However, as a business, I can’t refer to the people who seek my service as “members.” But maybe that’s something I need to give thought to for the future.

As such, I prefer the word “client.” Despite the negative stigma it might have in a mental health context, I see it as a more neutral word, because it is used neutrally in other contexts. And quite simply, it feels right to me. However, I am open to being persuaded in a different direction. And in any case, I prefer to refer to the people I serve by their first names. But it’s not right for me to use first names (much less last names) when I tell third parties not part of my clinic that someone has an appointment with me. So “client” it is. For now, at least.